MRI for Cervical Spine Cancer Detection

The spine is made up of 33 vertebrae, seven of which make up the cervical, or neck area (C1 - C7)¹. It also contains and protects the spinal cord, which functions as a complex bundle of nervous cells that help send and receive signals to and from the rest of our body. 

MRI is especially valuable for detecting early-stage cancer in the cervical spine. MRI can detect subtle changes in bone marrow, showing tumour infiltration before it becomes visible on other imaging tests². Faint abnormalities in the spinal cord, such as T2 signal changes, can be detected before X-ray or CT, allowing for earlier intervention and more effective treatment planning³.

When interpreting a cervical spine MRI, three key checks are conducted:

• Vertebral level involved: Identifying which vertebral segments are causing symptoms helps target treatment and understand which nerves may be affected⁴.
• Alignment: Ensuring the spinal cord remains centred within the canal is crucial. Misalignment may indicate instability, trauma, or mass effect from a tumour or disc herniation⁵.
• Spinal canal diameter: Assessing whether the spinal canal is wide enough to safely house the spinal cord⁶. Narrowing (stenosis) increases the risk of nerve compression, pain, and neurological deficits.

Learn more about MRI for cancer detection here.

Why You Might Need a Cervical Spine MRI (Neck MRI)

There are several reasons why a cervical spine MRI might be ordered, including:

Persistent Neck Pain and Nerve-Root Compression

• Neck pain that does not improve with conservative treatment, especially when accompanied by arm numbness or weakness, may indicate nerve root compression (neuroforaminal narrowing), such as from a herniated disc or a bone spur⁷.
• Symptoms are often described as sharp, shock-like, or pins-and-needles sensations radiating into the arm or hand⁸.
• MRI is the preferred imaging technique to visualise nerve root impingement and spinal cord involvement⁹.

Red Flag Cancer Clues

• Red flag symptoms include a history of prior malignancy, unexplained rapid weight loss, or night pain, raising suspicion for cancer spread (epidural metastasis)¹⁰.
• MRI is highly sensitive for detecting early spinal metastases and marrow infiltration, often identifying cancer-related pathology before it appears on other imaging studies¹¹.
• Urgent MRI is recommended for new neurological deficits or suspicion of metastatic spinal cord compression¹².

Post-Surgical Assessment

• After cervical spine surgery (such as fusion with plates or screws), MRI is used to monitor for complications, including hardware loosening, infection, or persistent nerve compression.
• Advanced MRI protocols can minimise artefacts from metal implants, enabling the assessment of implant integrity and the detection of issues such as a loose cervical screw¹³.

High-Energy Trauma Evaluation

• Following high-energy trauma, MRI is crucial for detecting hidden injuries at the atlanto-axial (C1-C2) junction- the skull-spine connection¹⁴.
• MRI can directly visualise ligament integrity (such as the transverse atlantal ligament) and assess for instability or occult injury, which is vital for preventing neurologic deterioration¹⁵.

Evaluate your cancer risk with our 5-minute quiz.

How To Prepare for Your Cervical Spine MRI

Here are a few tips to help you prepare for your MRI¹⁶:

• Take your usual medications and eat normally, unless instructed to fast for sedation or contrast. Avoid heavy caffeine intake and stay hydrated.
• Inform staff about any metal implants or devices, and bring safety cards for “MR-Conditional” implants, such as pacemakers or aneurysm clips.
• Remove all metal items, including jewellery, hairpins, dental plates, and transdermal patches with foil, to prevent image distortion.
• Bring your referral, prior brain images, and insurance pre-authorisation to avoid delays.
• Wear comfortable, metal-free clothing; ask about earplugs, music, or mirror goggles if you’re claustrophobic.
• If contrast is planned, fast for 4–6 hours prior to the procedure. Inform staff about any kidney issues or past reactions to contrast agents, as safer alternatives may be available.
• Arrange an escort home if you need sedation for claustrophobia.

You can read more about preparation for Ezra’s Full Body Scan here.

What Happens During the Cervical Spine Scan?

Upon arrival for your MRI, you will need to check in and complete a screening form. This will allow you to confirm the presence of implants, allergies, and whether you might need any anxiety medication.

During the MRI, you’ll lie on your back with your head and neck positioned in a special coil that helps capture high-quality images¹⁷. The scan typically covers from the base of your skull (C0) down to the upper thoracic spine (T2), ensuring that no important region is missed.

The technologist will acquire several sets of images, known as sequences, each designed to highlight different tissues and problems. High-resolution sagittal views allow precise measurement of disc height at every level and can reveal changes in disc signal intensity, which may indicate degeneration or injury¹⁸.

You’ll hear a series of loud knocking or tapping sounds as the MRI machine works. This is completely normal. The scan usually takes about 20 to 45 minutes, and you’ll be offered earplugs or headphones to make the experience more comfortable. 

The different sequences, such as T1, T2, short tau inversion recovery (STIR), and sometimes post-contrast images, can reveal subtle abnormalities, such as cavities within the spinal cord (syringomyelia) or areas where the spinal canal has collapsed¹⁹. These detailed images help doctors identify issues such as nerve compression, disc herniation, tumours, or post-surgical changes, all in a single scan. 

You’ll stay in touch with the team via a two-way intercom and a squeeze bulb, allowing you to communicate or pause the scan if needed. If contrast is required, it’s injected halfway through, possibly causing a brief cool sensation. After the final sequence, the coil is removed, and you’re free to go. 

At Ezra, our Full Body Plus scan takes around 60 minutes total, with 45 minutes of table time. Earplugs or headphones are available.

MRI Safety, Risks, & Side-Effects

MRI is generally considered very safe when proper screening and protocols are followed, but certain risks and side effects should be understood:

• Metal and implants: The strong 3-Tesla magnet can pull or heat older pacemakers, aneurysm clips, or metal fragments²⁰. Most modern “MR-Conditional” devices (like cochlear implants or pain pumps) are safe after screening, but all implants must be checked before scanning²¹.
• Gadolinium contrast: Macrocyclic gadolinium agents (e.g., gadobutrol) have an extremely low risk of allergic reactions or nephrogenic systemic fibrosis (NSF) when kidneys are healthy²². However, gadolinium can accumulate in tissues, and rare side effects such as headaches or skin changes have been reported. Many centres now offer contrast-free alternatives for routine follow-up²³. You can read more about gadolinium contrast side effects here.
• Incidental findings: Thyroid nodules are found in 6-16% of cervical MRI scans²⁴. Most are benign, but some may warrant further evaluation to rule out malignancy. 
• Claustrophobia: Anxiety inside the scanner is common. Wide-bore scanners, music, mirror goggles, or a single dose of oral sedative can help alleviate symptoms. Open MRI is an option if image detail can be sacrificed.
• Zero Ionising Radiation: MRI uses magnetic fields and radio waves, not X-rays, so there is no ionising radiation exposure, making it safer for repeated scans compared to CT scans²⁵.
• Minor Sensations: Expect loud knocking, mild table vibration, and a brief cool flush if contrast is injected. Rare side effects include headaches, fatigue, or mild skin heating.

A deeper dive into possible side effects (such as heat, headaches, and gadolinium deposition) is available in our full guide.

At Ezra, we employ a contrast-free approach using wide-bore T3 machines to deliver a comfortable scanning experience.

Terms You Might See in Your MRI Report (And What They Mean)

There are a number of terms you might see in your MRI report after your cervical spine scan. Here are some explanations for some common ones:

• Canal stenosis: Your spinal canal is narrower than normal, which can put pressure on the cord or nerves²⁶.
• Neuroforaminal narrowing: The exit hole for a nerve root is tight, often due to disc herniation or joint overgrowth, which can pinch nerves²⁷.
• Myelomalacia: Softening of the spinal cord, seen as a bright spot on MRI, indicating chronic pressure or injury²⁸.
• Synrinx/syringomyelia: A rare disorder where a fluid-filled cavity forms inside the spinal cord; the report will describe its size and extent²⁹.
• Modic changes: Changes in the bone marrow signal at the ends of vertebrae, hinting at disc degeneration³⁰.
• Facet arthropathy: Wear-and-tear arthritis in the small stabilising joints behind each vertebra³¹.
• PLL bulging/OPLL: The posterior longitudinal ligament is bulging or turning into bone (ossifying), which can crowd the spinal canal³².
• Osteophyte complex: Bony spurs that may narrow the spinal canal or nerve exits³³.
• Hardware loosening: Movement or backing out of fusion screws or plates after spinal surgery. 

Ezra provides a radiologist-reviewed report in a non-technical and easy-to-understand format on your dashboard³⁴.

After the MRI Scan

After the MRI scan, you will be free to go home and continue with your day without any precautions³⁵. If you received a sedative, you will need another person to pick you up. You will also not be able to drive, consume alcohol or operate heavy machinery 24 hours after the sedative. 

A team of experts will review your results and determine whether a follow-up is necessary and recommend the appropriate treatment if needed. If abnormalities are found, you may undergo ongoing monitoring every 2-3 months to track recurrence. You can receive support in the form of counselling and advice on how to handle aspects like claustrophobia. 

If you have a scan with us here at Ezra, you will receive your report within five to seven days and have the option to discuss it with a medical practitioner. You can also access your scan images through the online portal.

What MRI Can Show About Cervical Spine Cancer

MRI is a powerful tool for detecting and evaluating cervical spine cancer, often revealing abnormalities long before other imaging methods.

Early Marrow Changes

MRI can detect subtle changes in the bone marrow within the vertebrae at an early stage, well before these changes are visible on X-ray or CT scans. These early alterations, such as decreased signal intensity on T1-weighted images and increased signal on STIR sequences, may indicate tumour infiltration or marrow swelling (oedema), providing a critical head start for diagnosis and treatment planning^36,37.

Tumour Infiltration and Spread

MRI excels at mapping the precise extent of a tumour, including its infiltration into bone, the epidural space, or surrounding soft tissues³⁸. It can show whether a tumour has breached the vertebral body, invaded the spinal canal, or extended into paraspinal tissues. This level of detail is essential for surgical planning and assessing the risk of spinal cord compression or instability³⁹.

Indirect Damage: T2 Hyper-Intensity and Myelopathy

One of the key indirect signs of cancer-related damage on MRI is a bright signal within the spinal cord on T2-weighted images^40,41. This T2 hyperintensity often signals early myelopathy, indicating that the spinal cord is under pressure or has suffered injury, even before severe symptoms develop. Such findings can prompt urgent intervention to prevent permanent neurological deficits.

Paraspinal Soft Tissue Swelling and Canal Compression

MRI is also highly sensitive to swelling of the paraspinal soft tissues and can detect compression of the spinal canal by bone spurs, tumour mass, or inflamed tissues^38,39. These changes may not be apparent on other imaging modalities but are crucial for diagnosing the cause of pain, neurological symptoms, or impending spinal cord compromise. 

Ezra utilises DWI as part of our whole-body MRI scans and artificial intelligence (AI) to enhance MRI images and convert radiology reports into layman's term translations.

Types of Cervical Spine Tumours and How They Look on MRI

• Metastases: Metastatic lesions in the cervical spine usually appear dark (hypointense) on T1-weighted images and often bright (hyperintense) on STIR or T2-weighted images due to their high water content⁴². They typically enhance with contrast and may narrow the spinal canal or enlarge existing osteophyte complexes by replacing normal marrow and causing bone destruction or expansion.

• Intradural/Extramedullary Tumours (Meningioma, Schwannoma): These tumours are located inside the dura but outside the spinal cord. They commonly compress the cord without invading the bone. On MRI, meningiomas and schwannomas are usually well-circumscribed, isointense to hypointense on T1-weighted images and isointense to hyperintense on T2-weighted images, with strong enhancement after contrast administration^43,44. They may cause displacement or compression of the spinal cord, but rarely invade vertebral bone.
• Intramedullary Gliomas: These gliomas expand within the spinal cord itself and often exhibit long-segment T2 hyperintensity^45,46. They may be associated with a syrinx (fluid cavity within the cord) and can coexist with a Chiari malformation, in which case the radiologist will note the extent of tonsillar descent. These tumours are typically iso- to hypointense on T1 and hyperintense on T2, with variable contrast enhancement.

Primary Bone Tumours (Chordoma, Osteosarcoma) and Lymphoma-like Lesions: Chordoma tumours appear as a loculated mass with high T2 signal, often with an extra-osseous soft tissue component. They may show areas of high T1 signal, due to haemorrhage or calcification⁴⁷. Osteosarcoma shows low T1 and variable T2 signal with extra-osseous extension; mineralisation may appear as low T2 signal foci⁴⁸. Lymphomas typically present as a mass replacing marrow, with low to intermediate T1 signal and increased signal on fluid-sensitive sequences (T2/STIR), often with soft-tissue extension.

Vertebral Artery Anomaly at C1-C2: Any vertebral artery anomaly in the upper cervical region (C1-C2) is critical to identify before surgery, as it may complicate tumour resection or stabilisation procedures⁴⁹. MRI and MR angiography can help flag such anomalies for surgical planning.

Ezra screens for over 500 conditions and 13 organs, including the spine. 

Types of MRI Scans Used in Cervical Spine Cancer Detection

There are multiple types of MRI scans, all using different methods to give a better visualisation of cervical spine tumours. 

• Routine Sagittal T1/T2 and Axial T2 Sequences: These are the foundational MRI sequences for evaluating cervical spine anatomy, intervertebral discs, and the presence of tumours or structural abnormalities⁵⁰. Sagittal images provide a broad overview, while axial images allow precise localisation of lesions and assessment of neural foramina and the spinal cord.
• STIR or Fat-Suppressed T2 Sequences: Short Tau Inversion Recovery (STIR) or fat-suppressed T2-weighted images are highly sensitive for detecting bone marrow infiltration by cancer and identifying pre-vertebral soft tissue oedema⁵¹. These sequences help distinguish tumour involvement from normal fatty marrow, which is critical in early cancer detection.
• Post-Contrast T1-Weighted Imaging: After administration of gadolinium contrast, T1-weighted images are used to map the full extent of tumour infiltration, evaluate enhancement patterns, and assess the interface between tumours and any spinal hardware (such as plates or screws)⁵². This is essential for surgical planning and monitoring post-operative changes.
• Diffusion-Weighted Imaging (DWI): DWI is valuable for differentiating between an abscess (infectious phlegmon) and a solid tumour mass. Abscesses typically show restricted diffusion (bright on DWI, dark on ADC maps), while most solid tumours do not, aiding in accurate diagnosis and treatment decisions⁵³.
• 3-D Gradient-Echo Imaging: Three-dimensional gradient-echo sequences provide high-resolution images of the cervical spine, clearly delineating the posterior longitudinal ligament and other fine anatomical structures⁵⁴. These sequences are particularly useful for assessing ligament integrity and subtle tumour invasion or compression.

MRI vs. Other Imaging Tests for Cervical Spine Cancer Detection

MRI Scan Cost

Ezra’s Full Body Plus MRI scan in the UK costs £2,695 and is currently available at their partner clinic in Marylebone, London, with more locations planned in the future.

No referral is required, so you can book your scan directly without first consulting a GP or specialist.

Most people pay out-of-pocket, as insurance typically does not cover self-referred scans, but you may be able to seek reimbursement depending on your policy. 

Frequently Asked Questions

What is a cervical spine MRI?

A cervical spine MRI is a non-invasive scan that uses magnetic fields to create detailed images of the neck’s bones, discs, spinal cord, and surrounding tissues.

Does a cervical MRI show shoulders?

A cervical MRI focuses on the neck region, but the upper parts of the shoulders may appear at the edges of the images.

Will an MRI of the neck show cancer?

‍Yes, an MRI of the neck can detect tumours, cancer spread, and related changes in the cervical spine or surrounding soft tissues.

What does an MRI of the neck show?

‍It shows the vertebrae, discs, spinal cord, nerve roots, ligaments, and nearby soft tissues, helping to identify injuries, degeneration, or disease.

Does your whole body go in for a cervical spine MRI?

‍No, typically only your head and upper shoulders enter the scanner for a cervical spine MRI.

Does a cervical MRI show the brain?

‍A cervical MRI may show the lower part of the brainstem and cerebellum, but it is not designed to image the entire brain.

Why would a doctor order an MRI of the neck?

‍Doctors order a cervical spine MRI to investigate persistent neck pain, nerve symptoms, trauma, suspected cancer, or post-surgical complications.

Key Takeaways

• Cervical spine MRI is the most sensitive and earliest test for detecting neck tumours, disc collapse, and spinal cord damage. It can reveal abnormalities before symptoms become severe or before other imaging methods, such as X-rays or CT scans, show any changes.
• Early detection with MRI enables faster and more precise treatment, which can help prevent serious complications, such as paralysis or the need for major surgery. By identifying subtle marrow changes, tumour infiltration, or spinal cord compression at an early stage, MRI allows doctors to intervene promptly and tailor therapy to each patient’s needs.
• MRI of the cervical spine provides unmatched detail, allowing for early diagnosis and targeted management of serious neck conditions, ultimately improving patient outcomes and reducing the risk of long-term disability.

Ready to take proactive steps for your health? Book an Ezra full-body MRI today to detect any issues early and put you on the road to long-term health. Our yearly scan screens for potential cancers early, using AI to enhance the process, making it more efficient and affordable.